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Fields marked * are required.

Title*

First Name*

Last Name*

Street Address

Home Suburb*

Home State*

Home Postcode*

Home Phone

Work Phone

Fax

Mobile

Please note either a mobile phone number or email address is required to continue with registration.

Email

By supplying your email address you give Chitchat Research permission to email you with any projects that may suit your profile.

Preferred Contact Method*

Date of Birth*

Gender*

MaleFemale

Do you have children?*

YesNo

Current Work Status *

Employment Type (if applicable)

Occupation - Type

Occupation - Industry

Personal annual income *

Household annual income *

Main Bank

Housing Status *

Marital Status *

Married/long term partner, children at home

Married/long term partner, no children at home

Divorced/separated, children at home

Divorced/separated, no children at home

Single

Work Postcode

How did you hear about us? *

If a friend referred you to our website for registration, please insert their name here (they could win a prize for your referral)

Do you complete over 60% of the grocery buying for your household?

*

Yes

No

How often would you visit A KFC, McDonalds, Red Rooster, or Subway outlet and purchase something for yourself?

More often than once per week

At least once per week

At least once per fortnight

At least once per month

Less than once per month

Never

By ticking this box you are indicating that you accept, understand and agree to the Terms and Conditions contained at http://www.chitchatresearch.com.au/terms-conditions and you also authorise Chitchat Research to collect, use and disclose your personal and/or sensitive information in accordance with Chitchat Research's privacy policy.